Clinical Question: Is dosing topical corticosteroids more than once a day better than once-daily dosing for atopic eczema?

Setting: Outpatient (any)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors searched the literature for randomized controlled trials (RCTs) that compared once-daily dosing of topical corticosteroids with more frequent dosing for atopic eczema. Studies of seborrheic eczema, varicose eczema, discoid eczema, and contact dermatitis were excluded. The two primary outcomes consistent among most trials were “at least a good response or 50 percent improvement” and “eczema rated as cleared or controlled.” The meta-analysis was well executed with a comprehensive search, a good description of inclusion criteria, careful abstraction of data, and an appropriate analysis. Of the 10 RCTs that enrolled a total of 1,819 patients, one trial involved a highly potent steroid, eight involved potent steroids, and one involved a moderately potent steroid.

Results among trials were heterogeneous, making it inappropriate to combine the results. Review of the individual trials showed little support for dosing more than once a day; only one of seven trials showed a benefit regarding “at least a good response or 50 percent improvement,” and only one of six showed that eczema was “cleared or controlled.” Most trials showed no differences among dosing regimens.

Bottom Line: Patients should begin with once-daily dosing of topical corticosteroids for atopic eczema, increasing to two or three times per day only if symptoms are not well controlled. (Level of Evidence: 1a–)